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Global Health Initiative: How PEPFAR Fits In

About the Author: Ambassador Eric Goosby serves as the U.S. Global AIDS Coordinator, leading all U.S. Government international HIV/AIDS efforts.

Earlier this month, the Obama Administration revealed an important new piece of its foreign policy agenda: a consultation document on the strategy for the Global Health Initiative (GHI). This document outlines the U.S. Government's operation plan for the GHI, emphasizing integration of programming, implementation of sustainable efforts, efficient approaches with positive results and collaboration among partners.

As described in the consultation document, the GHI will support partner countries in their efforts to improve the health of their people, with a particular focus on improving the health of women and children. As a cornerstone of the GHI, U.S. President's Emergency Plan for AIDS Relief (PEPFAR) is a critical piece of this initiative.

As a result of the remarkable successes the United States Government has achieved with partner nations against HIV/AIDS, malaria and tuberculosis in the past decade, the GHI seeks to expand existing U.S. Government commitments to broaden the impact of our activities upon broader health systems. As the U.S. Global AIDS Coordinator, I welcome the GHI commitment to further PEPFAR's efforts in HIV/AIDS, and I look forward to building upon the tremendous successes PEPFAR has achieved.

Reflecting the principles of the GHI, under our new PEPFAR Five-Year Strategy, PEPFAR is transitioning from an emphasis on an emergency response to a sustainable one. To accomplish this, PEPFAR is working with partner governments to increase their ownership of, and capacity to lead, HIV/AIDS responses in country. Achieving this outcome requires a heightened effort to improve health systems at the country level. PEPFAR will deepen our work with countries to expand their capacity to deliver the health interventions they designate as priorities. As we build health systems, PEPFAR will also use these systems as a platform to directly support treatment for more than four million individuals living with HIV/AIDS, prevention of more than 12 million new infections, and care for more than 12 million individuals affected and infected by HIV/AIDS, including 5 million orphans and vulnerable children.

Cultivating a sustainable response to the range of global health issues is no easy task. The Administration is dedicating unprecedented funding -- totaling $63 billion over six years -- towards the GHI. This figure is nothing short of remarkable: compared to the preceding six-year period from 2003-2008, this resource commitment for 2009-2014 represents more than a doubling of funds. Included in this in an increase in funding for PEPFAR, allowing us to expand the reach and maximize the impact of our HIV/AIDS programming.

This initiative represents a new and innovative way of doing business for the U.S. Government, promoting coordination among agencies and programs to avoid duplication of efforts and maximize the impact of each dollar invested. As part of GHI, PEPFAR will work closely with other United States Government programs to build the efficiency and effectiveness of national health systems, strengthening their ability to meet the variety of health needs individuals face, including HIV-related needs.

The GHI prioritizes a woman- and girl-centered approach. Over the long term, improving the health of women acts as a positive multiplier, benefiting not only the health but the social and economic development of future generations. PEPFAR also embraces this approach in our strategy, recognizing the disproportionate impact of HIV on women and the centrality of women to the health of their families and communities.

The GHI principles also reflect the reality that improving global health outcomes is a shared responsibility, and emphasizes collaboration with country and international partners. To sustain the gains made on HIV, we will strengthen our partnerships with the multilateral community, non-governmental organizations and the private sector.

PEPFAR has accomplished great success since its inception over six years ago, and now as part of the GHI, I look forward to implementing President Obama and Secretary Clinton's vision to build on our achievement in the fight against HIV/AIDS.

Comments on the GHI consultation document can be sent to ghi_comments@state.gov. The deadline for comments is February 22, 2010.

Let us all praise the U.S. emphasis on women and girls in the GHI and PEPFAR principles and programs. Their needs have not been adequately addressed ever, on all health-related matters, not just HIV/AIDS.

But why can't Goosby and the State Department also show some damn concern about gay men and HIV? Given the past year's turmoil and political harassment for gays in Uganda, Kenya and Malawi, where PEPFAR dollars flows, and gay men living with AIDS are doubly-stigmatized, we really need these U.S. officials giving visibility to gays.

Adding insult to injury, the PEPFAR consultation document that Goosby thinks is so wonderful, and will be the guiding force to the program, fails to mention gays or men who have sex with men once.

The outrageous invisibility created by the Dip Note blog post and the PEPFAR document greatly strengthen the stigma already faced by gay men and gays living with AIDS. If Goosby and the State Department are too chicken to say something, _anything_, about gay men and HIV in 2010, we have a clear example of a problem in need of addressing.

willson s.

March 3, 2010

Wilson S. writes:

This is a very interesting post, and the comments are also fantastic to read. I’ll have to have a little re-think about my own contact form on our new website, as this poses some interesting questions!

Clarence M.

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South Africa

March 3, 2010

Dr. Clarence M. in South Africa writes:

Dear Ambassador Goosby, I could not agree with you more. PEPFAR has saved millions of lives in developing countries but in South Africa after our denialist politics it saved not only the lives of the ill and destitute AIDS patients but believe me it saved the lives of doctors and other care givers who were angry and some of them suicidal because of the helplessness they felt. I was one of them.

The Global Health initiative is taking off from there and giving us our pride back. In South Africa we are moving ahead with the formation of Public Private Partnerships. I work for the only Molecular Biology Laboratory PEPFAR partner in the world. We have recently signed a PPP agreement with the National Health Laboratory Service in South Africa.I met you at the department of health when you came down with the Clinton Foundation delegation. We support the GHI wholeheartedly. We will write a seperate email to you about the lack of support we are experiencing from fellow PEPFAR Partners

tony e.

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Nigeria

April 26, 2010

Tony E. in Nigeria writes:

please,As you people build health systems, PEPFAR will also use these systems as a platform to directly support treatment for more than four million individuals living with HIV/AIDS, prevention of more than 12 million new infections, and care for more than 15 million individuals affected and infected by HIV/AIDS, including 1 million orphans and vulnerable children.in the world like africa.